The first podcast for the TRUUD (Tackling the Root Causes Upstream of Unhealthy Urban Development) research programme explores how we value health and the opportunities to shape urban environments for healthier lives.
Host Andrew Kelly interviews Daniel Black, TRUUD Research Co-Director and Professor Jim McManus, Public Health Wales, about the TRUUD programme, which examines the interplay between property, transport systems, and public health, aiming to reduce non-communicable diseases and health inequalities through preventative measures.
Discussions cover the definition of upstream determinants of health, the barriers to implementing preventative public health policies, and the importance of cross-sector collaboration and assigning value to health outcomes. Examples of successful initiatives in Wales and inspiration from other countries are highlighted, along with book recommendations for further learning.
Funded by the UK which aims to reduce non-communicable diseases such as cancers, type-2 diabetes, obesity, mental ill-health and respiratory illnesses, TRUUD is providing evidence and tools for policy-makers in government and industry.
Six partner universities bring expertise and skills from public health, law, psychology, management, systems engineering, environmental and health economics, real estate, planning, urban development, policy and public involvement disciplines to the £10m programme with several industry, public and third sector partners.
Find more at the TRUUD website: https://truud.ac.uk/
Music credit: New York London Tokyo by Petrenj Music
Produced by Beeston Media.
Image credit: Madrugada Verde
Transcript:
00:00:03 Andrew Kelley
Welcome to the first of five TRUUD podcasts.
00:00:06 Andrew Kelley
From the University of Bristol, I’m Andrew Kelly. TRUUD looks at how we can shape places for healthier lives. In the next 5 podcasts, I’m going to be discussing valuing public health action for policy now in creating healthier.
00:00:20 Andrew Kelley
Places and societies, the governance and policy challenges we face, thinking about systems, systems change and making change stick for the long term. How we involve more people and communities in making change happen.
00:00:33 Andrew Kelley
And the future of Urban Development and how we find the investment needed. Thank you to UK prevention research partnership for funding TRUUD. For this first podcast I’m joined by Daniel Black, Co director for TRUUD, and Professor Jim McManus, national Director of Health and well-being in Public Health Wales.
00:00:54 Andrew Kelley
Jim is also deputy chair of the UK Prevention Research Partnerships Scientific Advisory Board. Daniel is in the studio with me and Jim is joining us from public health.
00:01:06 Andrew Kelley
Daniel, TRUUD started in 2019. How did it start and and what’s it been doing?
00:01:13 Daniel Black
It actually started prior to that there was a three-year pilot project funded by welcome, which was interested in changes to the wider environment and how it’s impacting on health.
00:01:23 Daniel Black
But broadly, the TRUUD program was a much larger initiative based on that pilot and the aim was to try and understand the property and transport systems in the UK.
00:01:36 Daniel Black
And where best we could intervene in those systems in order to improve health and specifically what the funders wanted to see was a reduction in non communicable diseases and health inequalities.
00:01:51 Andrew Kelley
Just to explain some of these points for us. So first of all, you talk about upstream determinants of health. What are downstream, midstream and upstream determinants of health?
00:02:01 Daniel Black
We use the term downstream to refer to the health outcomes in particular and the term midstream to refer to the built environment itself, but also the professions, the technical professions involved in that space. So architecture, engineering, planning, etcetera and so in our particular context and lots of others.
00:02:22 Daniel Black
Use upstream in a different way, but we’ve been using upstream to refer to the really key influential decisions that are taken even further upstream from the design space and the built environment itself. For example, issues around policy making, control of land.
00:02:40 Daniel Black
Decisions around investment finance, that sort of.
00:02:42 Andrew Kelley
Thing, but the essence of this work is that prevention is better than cure. It’s cheaper and it’s better for.
00:02:48 Daniel Black
People absolutely. Prevention is at the heart of the the entire project, and in fact the the term prevention itself also bears looking into, because when you’re in.
00:02:49
At.
00:03:00 Daniel Black
The health world prevention can mean things like early intervention on cancer prevention, that kind of thing. Whereas what we’re talking about is Intel.
00:03:08 Daniel Black
Meaning.
00:03:08 Daniel Black
Far, far, far beyond before you know cancers or or any other non communicable diseases even appear. So we do need to be clear about when we are talking about prevention, what kind of prevention we’re talking about.
00:03:21 Andrew Kelley
And when it comes to non communicable diseases, the figures are quite staggering, aren’t they?
00:03:26 Daniel Black
Absolutely yeah. 80% of all deaths are due to non communicable diseases that used to be infectious diseases were the the biggest challenge for us. But non communicable diseases have now outstripped infectious disease. And it’s not just in the industrialized nations, but this is a global phenomenon.
00:03:42 Andrew Kelley
And and just finally give us some examples of non communicable diseases.
00:03:45
Yes.
00:03:46 Daniel Black
Anything that’s not infectious effectively, that’s a disease, so cancers, diabetes, respiratory illness, cardiovascular disease, etcetera.
00:03:55 Andrew Kelley
Thank you. Turning to you, Jim, you work in public health. You’ve worked nationally and internationally on overcoming some of the barriers and challenges to a preventative approach. Can you tell us about some of these barriers and challenges?
00:04:08 Prof Jim McManus
Yeah, I think there are always barriers to preventive approach, especially if you’re working in public policy. So not so long ago.
00:04:16 Prof Jim McManus
I did some work on reasons why prevention fails and and came up with a a taxonomy for a project.
00:04:26 Prof Jim McManus
Unidentified 17 reasons and they fall into four groups for me, so there’s.
00:04:30 Prof Jim McManus
Either you have.
00:04:31 Prof Jim McManus
The wrong mindset, so you don’t define what it is you’re trying to do in the 1st place, which I think is one of the reasons why what?
00:04:36 Prof Jim McManus
Dan’s talking about is so important.
00:04:40 Prof Jim McManus
Or you have the wrong policy environment or you don’t understand the policy environment which is too often the.
00:04:46 Prof Jim McManus
On them.
00:04:47 Prof Jim McManus
Or you haven’t got what I call an authorizing environment. You haven’t actually got the the the will with all of different stakeholders together to give you the permission to proceed.
00:04:58 Prof Jim McManus
I think the third set of reasons is wrong set up you know wrong time skill, wrong intervention and then wrong implementation and poor implementation really does harm it so.
00:05:11 Prof Jim McManus
So in some ways, you might say, given all that, it’s surprising any prevention work gets done. My response would be to say to take a tool from health psychology called intervention mapping, which was big in the early 2000s, around actually plan really well what it is you’re going to do. Now. You’re going to do it because if you do, didn’t prevention.
00:05:31 Prof Jim McManus
Like program management will fail.
00:05:34 Andrew Kelley
And and how easy is it to to do this work in in a? In a modern democracy, you know which, where you, you have governments, which may only last four years, five years at the most.
00:05:47 Prof Jim McManus
For me, I think we haven’t got a choice. I remember the director of Public Health saying to me one day when we were all coming into local government in England.
00:05:56 Prof Jim McManus
And she said, why aren’t councillors accountable to us? And I just said democracy is such an awful thing, isn’t it? You know, get yourself elected leader of the Council and the well-being is my.
00:06:07 Prof Jim McManus
Response.
00:06:08 Prof Jim McManus
I think it’s good that if we’re doing anything scientific, we should be we should have to demonstrate in the public square the value.
00:06:16 Prof Jim McManus
Of what we’re doing.
00:06:18 Prof Jim McManus
I think it also emphasises that you know from the 1998 definition of public health, it is an art, the art of influencing as well as a science. It does make it a lot more complicated. It doesn’t mean that you end up with compromises in different values, and that means you know, someone coming from a public health background.
00:06:39 Prof Jim McManus
The value we would choose from the project might not be the value of that other.
00:06:43 Prof Jim McManus
The danger is when commercial actors try to get in that use health as a as a health wash products or services which are unhealthy and and also we pick quick solutions that actually turn out not to be. So a lot of the the things we did in the 60s we wouldn’t do now because they’re.
00:07:03 Prof Jim McManus
Harmful to health.
00:07:05 Prof Jim McManus
I don’t see any other way around it though. You have to get stuck in and get your sleeves rolled up and be part of the the the lay.
00:07:12 Andrew Kelley
Following on from that Daniel, how do we make health a priority across the whole of government?
00:07:17 Daniel Black
Well, that was one of our main findings from the research was that health is marginalised into, you know, the Department of Health possibly be thought about by different in the environment. But actually health is such a fundamental challenge for the whole of government.
00:07:34 Daniel Black
And so making health and prevention a top priority across government, at cabinet level, treasury, all the way through is absolutely fundamental.
00:07:44
So.
00:07:45 Andrew Kelley
Daniel TRUUD focuses on property development and transport in terms of HealthEquity talk us through that.
00:07:54 Daniel Black
It’s now well established that that buildings, property and transport have significant impact on disease, whether it’s through physical inactivity, lack of ventilation, damp mold, etcetera. So we’ve known for a long time that these are sectors that need to improve and of course.
00:08:15 Daniel Black
Health it’s not just about human health, it’s also about planetary health. And there’s been a huge amount of work in this space.
00:08:21 Daniel Black
But as I was saying in regards to our upstream focus, you know a lot of the technical professions know what to do. You know, they know how to design good buildings, they know how to design good transport networks. The problem is more systemic. It’s about issues of land control, issues of investment.
00:08:42 Daniel Black
And policy.
00:08:43 Daniel Black
Thinking and so yeah, hence the need to actually bring to coming to your point about inter and transdisciplinary, we need to bring a lot of different disciplines to bear to try and understand these complex systems and and understand what needs to change.
00:08:59 Andrew Kelley
And part of the true work is about assigning value to health outcomes.
00:09:04 Andrew Kelley
Do you think government gets that now?
00:09:07 Daniel Black
I mean, it’s a good question. I I mean I think it was the Cameron government that that instigated the Office of National Statistics and starting to to monitor well-being obviously conversations have been had for a long time in terms of replacing gross domestic product GDP as our main form of measurement. I mean these are not new topics of conversation.
00:09:28 Daniel Black
But certainly we seem to struggle hugely in trying to figure out how to overcome them. So I I think there’s definitely a lot of sympathy towards this kind of thing these days. One of the main pieces of work, inTRUUD has been the development of an economic valuation tool, which we’ve called house the health appraisal of urban systems.
00:09:48 Daniel Black
And it’s based on five systematic reviews from the public health researchers and a number of other systematic reviews by the economists and the government. The Ministry for Housing, Communities and Local Government do see the value of that, and they are due to be adopting it this summer, which is fantastic. It’s only going to.
00:10:08 Daniel Black
To be part of the solution, because we know it’s going to be a lot more complex than that and people make decisions based on all sorts of reasons, not just on pound signs, but it we hope and we the response we’re getting around it suggests that there’s a big.
00:10:22 Daniel Black
Demand for new ways of valuing these kinds of things. So it’s a step in the.
00:10:26 Andrew Kelley
Right direction, we’re we’re going to talk about that model in a in a future podcast talking about government. Jim, back with you, it seems to me that the Welsh Government does get some of these lessons and could be said to have led the way in this approach with the well-being of future generations.
00:10:43 Andrew Kelley
Act and the work of the future generations Commissioner, which has prevention at its core, how does this work, and how does it have an impact on on?
00:10:51 Andrew Kelley
Your work.
00:10:53 Prof Jim McManus
Well, I guess the first thing to.
00:10:54 Prof Jim McManus
Say is that that.
00:10:55 Prof Jim McManus
Whole future generations policy was one of the things that attracted me to working in males, and I think it’s an ambitious set of policies. It’s easier said than done, however, and I think the future generations Commissioner would acknowledge that. But it gives us a number of ways of working.
00:11:13 Prof Jim McManus
And one of the things that the Act sets out is behaviours.
00:11:17 Prof Jim McManus
Of public bodies and other actors. And I think that’s really good. The behaviours themselves don’t deliver prevention, but actually they do create the system conditions to enable prevention to happen. So that’s the first thing I think the second thing is it makes us think about what is the preventive volume, what is the future volume, what is the future.
00:11:37 Prof Jim McManus
Good thing, and I think that’s really good. And if you were to ask me or I would to volunteer anyway, 4 reasons why I think TRUUD is so important. Coming from a Welsh context, it be these firstly, because TRUUD actually gets into defining its terms of engagement.
00:11:56 Prof Jim McManus
And an awful lot of policy discourse and and some academic discourse and probably health is quite sloppy. You know, we’ve heard Dan talk about downstream, upstream and midstream. We need that you, you won’t get clarity unless you get clarity of those things. The second thing is the work on value we need to move beyond return on investment.
00:12:17 Prof Jim McManus
And actually look at value using multiplicity of methods and sources for public and private actor.
00:12:25 Prof Jim McManus
I think the third really important thing about TRUUD is the content, obviously. But the fourth thing is it is multidisciplinary. It takes all these disciplines together. And the thing I like about the Future Generations Act in Wales and Welsh policy is that it gives that in for multidisciplinarity and for disciplines working together.
00:12:45 Prof Jim McManus
So for me, I think there is an obvious thing about TRUUD applicability to Wales and the Welsh policy framework, and it will help us implement.
00:12:56 Andrew Kelley
You talked about the principle of the Future Generations Act and the Commissioner’s work, and sometimes it’s difficult to implement these things. Have you got any general lessons that you could draw down from that? For what food is trying to do in terms of delivery?
00:13:12 Prof Jim McManus
Yeah. I mean, I think it’s always important to be very clear about what you mean by prevention. What you mean by determinate what you mean by inequality?
00:13:20 Prof Jim McManus
Is.
00:13:20 Prof Jim McManus
And actually pinpoint what the issues are and who can act on them. We’re sitting at the minute working with sport rules and other national, one of our national sister bodies looking at what we can do more on physical activity and active travel in Wales. And that’s one of the approaches we’ve taken is actually a matrix of.
00:13:41 Prof Jim McManus
Of what is it we mean you can do more. So I think often you get in and try to change the world and actually precision is more in.
00:13:49 Prof Jim McManus
I guess the second thing is ways of working really develop sophisticated ability in policy analysis in systems analysis, in system leadership. And I think that’s another thing that TRUUD is trying to develop. So that for me is a if you don’t do those, you won’t get the system conditions. The third lesson for me.
00:14:10 Prof Jim McManus
Would really be about to articulating the why in simple ways of value that busy policymakers who have got something new every half an hour on their desk.
00:14:22 Prof Jim McManus
Can understand and empathise with. If I get a briefing with 61 pages, I turn it into a page because I know that it’s it’s not gonna get the impact otherwise, and I think that’s our perennial challenge in improving the health of populations.
00:14:36 Andrew Kelley
I mean, Daniel, when on the true website, there’s quite a few briefings and they’re all mercifully short, I find. But that’s been one of the aims, hasn’t it, to to get the message out to as wide a range of people as possible and to get their involvement in Co designing solution.
00:14:53 Daniel Black
Yeah, absolutely. I mean, it’s been a, a central challenge actually, because even resourcing the the communications exercise is not straightforward within academia. The main focus in academia is obviously on doing the research and doing it well, but actually there is this increasing demand for societal impact for real world.
00:15:14 Daniel Black
Impact and that requires much.
00:15:16 Daniel Black
More I don’t know what the word is, but prosaic type activities, communications and management and coordination and within the academic world, they call them professional services, but they’re actually absolutely fundamental for bringing all these different disciplines together and then communicating well to the outside world.
00:15:36 Daniel Black
And it’s not something that, you know, within the institutions themselves, the universities, they have good functions that that enable this. But within individual research projects, they don’t necessarily unless they’re particularly large, but this is what the funders are asking for. They want to see the research have impact.
00:15:52 Daniel Black
And these core functions are absolutely essential for.
00:15:55 Andrew Kelley
That and and what kind of reception have you had from planners and property developers, transport planners, as well as urban design planners?
00:16:05 Daniel Black
Huge amount of interest. I mean, we’re absolutely pushing at an open door, everyone across both public and private sector recognised that health is a massive issue. You know they they can see it. You know one of the first things we did in our pilot project was to try and understand how the different actors within the Urban Development space.
00:16:27 Daniel Black
Or what they knew about the links between the built environment and health outcomes, and most of them are well known. You know, every everyone knows about air pollution. Everyone knows about obesity. Everyone knows that diabetes is a significant issue. There are a couple that that are less familiar. You know, the links between, say, traffic noise and child conduct disorder and the cost of treating that.
00:16:47 Daniel Black
Child conduct disorder, or the links between air pollution and Alzheimer’s and dementia. So there are certain new ones that are coming out that people are aware of, but most people nowadays are very well aware and they recognise that it’s a societal challenge and everyone needs to do their bit. So yeah, very much pushing in an open.
00:17:04 Daniel Black
Your.
00:17:05 Andrew Kelley
And and Jim, what about you and work on future generations and health has, has there been a good response from private sector from from other colleagues in in Wales?
00:17:16 Prof Jim McManus
Yes, I would say so. I think the challenge is articulating what people need to do and how we do it. So we have a project at the minute which is working with all of the public sector service boards which are multidisciplinary, multi agency boards and.
00:17:32 Prof Jim McManus
Deals on wider determinants of health and health and equalities, and of course you need to say, well, what is it you can actually do so it it doesn’t all become about the NHS. It actually becomes about the conditions for a healthy, flourishing society, mentally, physically and socially.
00:17:53 Prof Jim McManus
We’ve got a program in Wales called Healthy Working Wales.
00:17:56 Prof Jim McManus
And and that’s based with employers and aims to get employers engaged. One of the things we’re looking to do is build a cadre of employers who will be peer ambassadors for healthy workforce because it’s actually enlightened self-interest to do so. And as an economic benefit to them.
00:18:14 Prof Jim McManus
So again, looking at some of the trade principles and the future generations principles.
00:18:20 Prof Jim McManus
You put those together and you are more likely, I think, to get a success than if you don’t use those as way markers for.
00:18:29 Prof Jim McManus
Germany.
00:18:30 Andrew Kelley
It’s interesting because I’ve had discussions in Bristol, for example, about.
00:18:34 Andrew Kelley
Do we need a future generations Commissioner here? The UK Government was looking at this at one point and that seems to have stalled and the response I sometimes get is well, we don’t need a Commissioner thinking about future generations should be the responsibility of everyone, which is true, although an act and a as someone dedicated to the task can be very valuable.
00:18:57 Andrew Kelley
I suppose the bigger question from this Daniel is how do we make the true work stick in the long term? What are you doing on that?
00:19:06 Daniel Black
So we’ve got the the economic tool that we mentioned, which will be which will be used going forward by government and we hope by combined authorities and and local government we’ve got the true website which is a a really fantastic resource. We hope people will use it. There are various videos for example on the use of health impact.
00:19:27 Daniel Black
Assessment. There are loads of briefing notes that people can make use of. The economic tool will actually be made available in a reduced format, but something that will be usable by a much wider group of people. And there are various guidance documents and and other things that will help people do their job better. We hope that that gets used a lot. I mean one of the one of the challenges of research.
00:19:47 Daniel Black
Which has a a start and end point is that you then need to get further research funding to carry on the work. So that is our challenge at the moment and we’re we’re actively looking to to what comes next the, the, the big challenge really is to how do we scale.
00:20:03 Daniel Black
These sorts of initiatives so that they become viable so that people can carry on using these types of approaches without needing large research grants. So that’s our next challenge is how do we how do we scale this up so that it’s affordable.
00:20:17 Andrew Kelley
And and Jim Thurston, then Daniel, second, who else is doing interesting work in other countries in other cities? Have you got any recommendations for us to look at?
00:20:27 Prof Jim McManus
I think the.
00:20:28 Prof Jim McManus
Australians are doing some exciting stuff, the Quebecois in Quebec.
00:20:33 Prof Jim McManus
Are trying to look at this area as well. There’s some interesting stuff going on in Italy around school environments, from the individual level right up to the societal level. Obviously there’s some really useful work going on in Scotland with cipher and I I have to say that there’s some good work going on involved in terms of how you get physical activity in case I get shot if I didn’t.
00:20:55 Prof Jim McManus
So and there is some good stuff, but I if I might say that I think for me one of the remarkable things about TRUUD is the way it has segmented the audience of people that’s trying to get messages to in a way that some projects like this haven’t done, you know, segmented audiences, segmented products. I think the New Zealand.
00:21:15 Prof Jim McManus
Welcome well-being is probably the one I’ve been most aspirational to copy, if I’m honest, but I would like to see in 10 years time a step change in how our public realm mitigates for health, mental and physical rather than sometimes against.
00:21:35 Andrew Kelley
Daniel, have you been inspired by anywhere else?
00:21:38 Daniel Black
Yeah, many places I’ve been talking for years and so have many urban planners of a place in South of Germany called Vauban or Vauban and also Rizal Feld. These are two urban extensions in a place called Freiburg and they really are extraordinary. They’re they’re high density cars, parking on the outside, high quality.
00:21:58 Daniel Black
High frequency tram network, as quiet as the countryside.
00:22:01 Daniel Black
They’re not necessarily replicable, and that’s just one example. I mean Copenhagen, I mean, Northern Europe generally is just has got some really exemplary, exemplary development. So in terms of actually what we’re trying to create, I would urge people to go and visit.
00:22:16 Andrew Kelley
So some interesting work going on in other countries about the ideas of well-being, for example, and some inspirational places to look at as well. We also ask all our guests to recommend a book or books for the true bookshelf. Daniel, what which books do you?
00:22:33 Daniel Black
And so I read a book recently which I really thoroughly recommend. It’s called the matter of facts by a father and son team, Gareth Lang and Rhodri Ava Lang called the matter of facts, scepticism, persuasion and evidence in science. And as someone who’s come in, if you like, sideways into academia, it was a really.
00:22:53 Daniel Black
Eye opening, enlightening portrayal of of the challenges that academia faces. You know it’s not. It’s not an ivory tower, just like any other system. There are issues, and there are lots of people trying to make sure that it is as robust as it it possibly can be and and they don’t question the value of it, but they do point out that.
00:23:12 Daniel Black
Actually, you know, it’s not quite as squeaky clean as as some people might make out. So it’s about how do we try and really test it, but in the nicest way possible so that we can use it in the best possible way. It’s absolutely brilliant. The the other one is the social amplification of risk by Nick Pigeon, Roger Casperson and Paul Slovic.
00:23:32 Daniel Black
And this was again another one I read cover to cover, which isn’t always the case, but introduced me to the idea of how we understand risks to society and how those risks are communicated. So again, I’d recommend both of.
00:23:45 Daniel Black
Those. Thank you and.
00:23:47 Prof Jim McManus
I mean, I guess as someone who started inhumanities and in social sciences before coming to public health, the thing I really want is a counter of public health people who are politically literate, who are literate in, in influencing. So the first book I’d recommend would be Christian basins leading public sector innovation, a really good book.
00:24:06 Prof Jim McManus
Times with the work of Mariana Maza Cartel and her stuff around. Actually, the private consultancies are not the source of all the innovation, the public sector and the voluntary sector can deliver that.
00:24:18 Prof Jim McManus
I think the the second one for me is Paul Kane. He’s become. Why isn’t government policy more preventive? He’s editing volume. I think that the thinking around the system condition is is really the important thing and that’s a brilliant springboard.
00:24:32 Prof Jim McManus
I have to.
00:24:33 Prof Jim McManus
Plug a Welsh book, especially being involved with this group of people, but wasn’t involved in the book.
00:24:38 Prof Jim McManus
A book on health economics of well-being and well becoming from Rhiannon, Tudor Edwards at Bangor actually takes a different approach to health economics and looks at valuing population health, and I’d encourage that because it changes our.
00:24:52 Prof Jim McManus
Mind. And if there were two other things I don’t have specific books, but I think we need public health professionals who are really good at policy analysis. Only decent book on policy analysis or any of the three courses on policy analysis. I used to teach policy analysis to public health registrars and some of them managed to stay awake.
00:25:14 Prof Jim McManus
But that’s really important and I think the other thing is really understand systems is, is it Diane Feingold, the Canadian some of her stuff is very good. And she said, look, if you wanna move the system, that’s quite stuck.
00:25:29 Prof Jim McManus
Intervene in enough places to disrupt it, but we’ve got to get beyond description and get into it. Final one is anything by Cormac Russell on building communities, because at the end of the day, we are only as good as the Community, infrastructure and Community networks of trust.
00:25:47 Prof Jim McManus
We can’t build those top down.
00:25:50 Prof Jim McManus
And that’s a long burn. So those those would be my kind of acid tests. We need to be very clear about what we’re wanting to do. And I think in this day and age, we need to have multiple methods of doing it and that means public health people need to read much more widely beyond epidemiology and beyond core disciplines.
00:26:09 Andrew Kelley
Thank you. Terrific choices and some important lessons there for us and we’ll be returning to some of the themes that Jim mentioned in future podcasts. I have my own recommendation. It’s a memoir. It’s by Alfred Kazan. It’s called the Walker in the city.
00:26:24 Andrew Kelley
Alfred Kaiser was one of that great group of intellectuals in 1950s America. His memoir covers him growing up, becoming a young man, finding his way into and around Brooklyn and Manhattan. I’ve read this many times and learned something new about cities each time, and it encouraged me to walk around other cities too.
00:26:43 Andrew Kelley
My takeaways from today deaths caused by non communicable diseases place an enormous burden on the NHS and taxpayers and of course on the people affected. The vast majority of these diseases are.
00:26:56 Andrew Kelley
We need to focus on prevention. We need to think about the interdisciplinary approaches needed, think about future generations, invest in long term research, and communicate that widely. Daniel will be back for our final podcast when we look at the future of Urban Development. Our next podcast looks at policy and governance challenges.
00:27:16 Andrew Kelley
For healthier urban places, the TRUUD website TRUUD.ac.uk has links to all podcasts, background research and issues and recommendations discussed today. Thank you, Daniel Black and Jim McManus for joining me today.
00:27:32 Daniel Black
Thanks, Andrew. It’s great.
00:27:33 Prof Jim McManus
Thank you.
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